Young women who experience repeated sexual assaults are at very high risk for posttraumatic stress disorder (PTSD), national surveys found.

Action Points

Young women who experience repeated sexual assaults are at very high risk for posttraumatic stress disorder (PTSD).

Point out that adolescent girls repeatedly assaulted also had significantly high rates of PTSD, as did adult women who were not college students.

Young women who experience repeated sexual assaults are at very high risk for posttraumatic stress disorder (PTSD), national surveys found.

College women who reported suffering multiple sexual assaults had a nearly seven-fold increase in the likelihood of having PTSD within the previous 6 months (OR 6.7, 95% CI 4.5 to 9.9, P<0.001), according to Kate Walsh, PhD, and colleagues from the Medical University of South Carolina in Charleston.

Adolescent girls repeatedly assaulted also had significantly high rates of PTSD (OR 5.1, 95% CI 2.9 to 9, P<0.001), as did adult women who were not college students (OR 5.8, 95% CI 4.3 to 7.8, P<0.001), the researchers reported in the September Archives of General Psychiatry.

Although previous studies have found high rates of PTSD, depression, and panic disorder among women experiencing sexual assault, little is known about the effects of two or more such experiences.

So Walsh's group surveyed 1,763 teenage girls, 2,000 college women, and 3,001 adult women residing at home, asking them about history of sexual assault and PTSD symptoms.

Current PTSD symptoms, as well as functional impairment due to those symptoms, were assessed during a diagnostic interview using a module of the National Survey of Adolescents and the National Women's Study.

During the interview, a participant responded "Yes or No" to questions on the presence of a PTSD symptom during her lifetime and in the previous 6 months.

"This measure was validated against the PTSD module of the Structured Clinical Interview for DSM-IV administered by mental health professionals," the authors explained.

Among the adolescent cohort, 11.6% reported at least one assault, and more than half of those had been assaulted twice or more.

A total of 20% of adolescents with multiple assaults had PTSD during the previous 6 months and 28.8% had a lifetime history of the disorder.

Among college women, 12.5% had been sexually assaulted, and half of these had two or more assaults.

A total of 40% of college women who had been revictimized had PTSD within the previous 6 months, as did 58.4% during their lifetime.

Of adult women not in college, 20% had been sexually assaulted at least once, with almost 60% of them reporting two or more events.

For those who had been revictimized in this group, 27.2% had past 6-month PTSD and 45.6% had lifetime PTSD.

On logistic regression analyses, the adjusted odds for lifetime PTSD were 4.3 (95% CI 2.7 to 6.9) among adolescent girls with revictimization, 8.2 (95% CI 5.6 to 12.1) for college women, and 5.9 (95% CI 4.6 to 7.5, P<0.001 for all) among household-residing women, compared with nonvictims.

Among the adolescents, those who were older were more likely to meet the criteria for lifetime PTSD (OR 1.2, P<0.001), while among household-residing women risk was associated with younger age (OR 0.98, P<0.001).

These findings imply that older adolescence and young adulthood are periods of notably high risk for revictimization and PTSD, according to the researchers.

Rates of PTSD among women with a single assault were considerably lower than for those who had been revictimized, at 13.4% for adolescents and women not attending college and 32% for college women.

"These findings have clinical implications in that screening for multiple victimization experiences, as opposed to only asking about the presence or absence of sexual victimization, may enhance practitioners' abilities to focus on women most likely to be at risk for psychiatric problems," Walsh and colleagues stated.

Treatment for revictimized women with PTSD may need to be more extensive, particularly for victims who blame themselves or are concerned for their safety.

The researchers also noted that, despite the high rates of revictimization seen in these groups of women and girls, PTSD never developed in 72% of adolescents, 40% of college women, and 55% of household residing women.

"Thus, resiliency to PTSD in the wake of multiple sexual assaults is not uncommon, and studying factors that promote resilience among these groups may better inform PTSD treatment and revictimization prevention programs," they suggested.

Behaviorally specific prevention programs for revictimization should be developed and implemented in schools, colleges, and community settings, and when victims are identified, they should be screened for PTSD so that appropriate referrals can be made, the researchers advised.

Limitations of the study included a lack of information about the severity of symptoms of PTSD, and the decision by some eligible women not to participate.

The study was funded by the National Institute of Child Health and Human Development, the National Institute of Justice, and the National Institute on Drug Abuse.

The authors reported no conflicts of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.